<div class="send-email">
    <div class="request-response msg msg-confirm copy" id="request-response"></div>
    <ul>
        <li><ul>
            <li><input type="checkbox" name="send_to" value="myself"></li>
            <li><input type="checkbox" name="send_to" value="staff"></li>
            <li><input type="checkbox" name="send_to" value="learners"></li>
        </ul></li>
        <li><input type="text" id="id_subject" name="subject" maxlength="128" size="75"></li>
        <li><input type="button" name="send"></li>
    </ul>
    <div class="request-response-error"></div>
</div>
